SUBMITTED BY-

SANJEET SINGH & YASHMIN SHEIKH

ORGANISATIONAL BEHAVIOUR

REPORT ON

INDIAN GOVERNMENT HOSPITALS &
MEDICAL CONDITIONS

STATICS OF INDIAN MEDICAL CONDITIONS
BRIEF INTRODUCTION
These are the hospitals which were made by the government for
public welfare. Health sector in India is the responsibility of the
state, local and also the central government. Healthcare in India
features a universal health care system run by the constituent
states and territories of India.

It's not hard to find people caught in the gap between India's
dreams of greatness and the awful reality of its broken health
system.
Standing in the crowded entrance hall in the outpatients department of New
Delhi's All India Institute of Medical Sciences (AIIMS), one of India's best
public hospitals
Hospitals form an important arm of the healthcare delivery system. Though
the focus of various National programmes may be on primary health but
secondary and tertiary public hospitals form one of the largest expenditure
category in the national health budget. Over the past decade, inspite of the
complexity of hospitals having increased many fold, not many changes have
been made in the management structure of public hospitals.
ORGANISATIONAL BEHAVIOUR CONCEPTS INCLUDED FOR
ANALYSING THE EVENT

Poor planning and management
Lack of co-ordination
No team work
Lack of motivation
Organisational structure
Behaviour
Time management
Insufficiency
Drawbacks


POOR PLANNING &MANAGEMENT
No learning
No use of advance technology
The equipments are outdated
Lack of governments commitment towards quality assurance
Low management capacities at health facilities
Lack of policies and guidelines from the State
Structural problems of the centralized health system
Deficiencies in the quality of services provided
Dismal sanitary conditions
Long waiting times
Rude behaviour of staff
Clinics are badly maintained and equipped.

3 REASONS WHY GOVERNMENT HOSPITALS IN INDIA SHOULD PROVIDE
GOOD QUALITY HEALTH CARE

1. PUBLIC HOSPITALS IMPOSE SIGNIFICANT OPPORTUNITY COSTS TO
THE SOCIETY
The care as such has a limited impact on the population health. Inspite of
this known fact a major chunk of healthcare budget is spent on secondary
and tertiary care which can be upto 40-50% of state healthcare budgets.
Thus infrastructure and administrative costs of hospitals carry a big
opportunity costs with them.


2. DECREASING UTILIZATION OF PUBLIC HOSPITALS FOR
INPATIENT AND OUTPATIENT CARE
80percent of households prefer to use private sector treatment in India for minor illnesses, and
75percent of households prefer to go to the private sector for major illnesses . Numerous other
studies have confirmed the dominance of the private sector and the reasons for this dominance:
government health services entailed longer waiting periods, arrogant behaviour of doctors and
non-availability of medicines .Even though the treatment in public hospitals is free, the patients
have to pay for tests, and bear the incidental costs of boarding and lodging .

The users dont prefer to use public facilities for medical services like Inpatient and Outpatient
services in contrast to other primary healthcare services especially in urban setup as per the
data published by National Sample Survey Organization (NSSO). The major public providers
which provide these services in urban setups are teaching hospitals and general hospitals.
There is a clear preference towards private providers despite of costly treatments in secondary
and tertiary domain. This data points towards the failure of public hospitals in meeting the
expectations of the public.

3. HEALTH EXPENDITURE INCURRED BY PATIENTS IN
PUBLIC HOSPITALS VS PRIVATE HOSPITALS
The services provided in public hospitals amount to a considerable fraction of the
costs in private hospital. Even after spending a comparable amount, all patient gets
is dismal sanitary conditions, long waiting times, rude behaviour of staff, high
infection rates and substandard clinical care. This is one of the prominent reasons
why the patients prefer private healthcare providers more than public hospitals.

POOR ORGANISATIONAL STRATEGIES
The same could be said of india's health system. Sixty years after independence,
India remains one of the unhealthiest places on earth. Millions of people still suffer
from diseases and ailments that simply no longer exist almost anywhere else on the
planet. Four out of five children are anemic. Almost one in four women who give birth
receives no antenatal care. What makes the picture even bleaker is the fact that
India's economic boom has had, so far at least, little impact on health standards.
There are other reasons for India's ill health. Over the past decade or so, funding for
public-health initiatives such as immunization drives and programs to control the
spread of communicable diseases has been cut; some critics blame shifting
government priorities.
THE PROBLEMS OF HEALTHCARE SYSTEM IN
INDIA
Indian healthcare system is plagued with numerous problems and too many laws. The solution
is to ensure that regulation is streamlined and proper viz. Clinical Establishment Act
It is said that "health is wealth"; but in India, health is getting increasingly unaffordable

STATISTICAL BACKGROUND
The doctor population in India is 1:1,500 when compared to an estimated 1:1,000 in China and
1:350 in the United States . In urban India, the ratio is estimated at around 1:500 while rural
India it is at around 1:2,500
There are about 9.2 lakh allopathic doctors in India and surprisingly about 7.5 lakh doctors
practicing 'alternate' medicine

India has about 12,760 allopathic government hospitals, with a bed capacity of 5.76 lakh
However, India has less than 1 bed per 1,000 population compared to a ratio of 3 for China and
3.1 for USA
PRIME PROBLEMS FACED BY INDIA'S HEALTHCARE
SYSTEM
'Capitation fees' has made it difficult for genuine students to pursue the medical
profession and could also be a cause for 'medical inflation'

There is a shortage of teaching staff in government hospitals due to a pay differential
compared to private institutes

There is no common nationwide entrance exam like JEE or CAT, for admission into MBBS

Referrals or commissions between doctors and pharmaceutical companies or hospitals
needs to be regulated
Lack of sanitation and proper hygiene is one of the root causes for illnesses to spread
and the healthcare system is unaffordable for many
In April 2010, the President of MCI and his two associates were arrested by the Central
Bureau of Investigation (CBI) while accepting a bribe of Rs2 crore to grant license to a
medical college in Punjab.
FUNDING/PAYMENT REFORMS
Reform of the funding and payment arrangements for public hospitals is
another common approach to address problems with productivity, efficiency,
quality, and responsiveness
Problems with productivity and efficiency are commonly addressed by
altering the structure of funding or payments to providers. These payments
reforms usually tighten the link between resource allocation and delivery of
specific outputs.
Different structural changes are made to funding and payments systems to
address concerns about clinical or consumer quality or responsiveness to
users

COMPETITIVE ENVIRONMENT/MARKET STRUCTURE
The structure of the market to which the reformed hospitals are exposed is a
critical influence on their behavioras it directly determines what strategies
will make sense to generate more revenue
Unfortunately, market structure is a problem in most segments of the health
sector. There are two related problems. First, little or no competition may
emergereducing pressures on the provider to deliver value for money in
order to maximize profits
Even for services where monopoly power is not an issue, providers may still
capture market share or maximize profits through various forms of
distortionary behavior
DRAWBACKS
Poor outcomes and insufficient resourcing
Health infrastructure Is well below WHO guidelines
Health workforce remain indequate and underutilized
Indian healthcare expenditure has grown slower than economy
About 50% of medical workforce do not practice in formal health system

ORGANIZATIONAL BEHAVIOR MANAGEMENT IN
HEALTH CARE

Organizational behavior management (OBM) focuses on what people do,
analyzes why they do it, and then applies an evidence-based intervention
strategy to improve what people do.
First, we need to define medical error. This task is neither simple nor
straightforward because the definition of a medical error varies markedly
across different hospitals and health care systems.
MEDICAL ERRORS TO TARGET WITH ORGANISED
MANAGEMENT

ERRORS REMAINING AFTER SYSTEM CHANGE

It is acknowledged that several types of errors are already being addressed by well -informed system-
based changes, but a number of categories of errors persist. These include technical errors during
care procedures, failures in communication among caregivers and between provider and patient,
contamination errors due to ineffective employee and patient hygiene, and lapses in patient
monitoring.

Diagnosis errors, such as using the wrong test, delays in diagnosis, and failing to act as indicated on
test results.
Treatment errors, such as ordering a wrong drug or dosage, accidental puncture or laceration, and
incorrectly executing a procedure.
Monitoring errors, such as bedsores, failure to rescue, and patient falls.
Infection-control errors, such as failing to wash hands, lack of glove use, and compromising sterile-
field maintenance.
Communication errors, such as failing to inform other caregivers of acute risk, changes in care, and
critical hand-off information, as well as ineffective communication with patients.


CONCLUSION
A significant amount of taxpayers money is spent on Government hospitals which puts
these hospitals in a critical position to be accountable for the quality of services and
deliver quality services within the constraints of available resources. It should be tried by
the public hospitals to prevent diversion of its customer to private setups due bad quality
of services. This warrants an existence of a quality management and control mechanism
for government hospitals.

Quality of service should not be denied just because the direct consumer is not asking for
it; but concrete measures towards quality assurance are necessary because lots of
money is being spent in providing the infrastructure and bearing the administrative costs
in the public hospitals. A few state governments (Gujarat, Kerala) are coming up with
answers to these questions by taking concrete actions towards quality assurance and
commitment for continuous quality improvement.

SOURCES OF INFORMATION
News channel reports
WHO reports
Wikipedia
Indian Medical association
Medical magzines